The Direct Care Doctor Will See You Now

Thanks to @jsgoldmd20 who linked us to a relevant Huff Post story. Ann Brenoff’s “The Doctor Will See You … When Her Boss Says She Can” documents her experience with an overly commodified fee-for-service doctor. It’s not the same old story, of long waiting rooms, harried visits, obscene fees, and dodgy insurance claims… Well, it does have the long waiting room, but for a different reason: Brenoff’s doctor refuses to spend less than 30 minutes with her patients, even when the company she works for demands she book appointments every 10-15 minutes.

The problem, though, is that patients back up in the waiting room. Even when her appointments are booked four weeks in advance, Ann Brenoff is forced to wait over an hour to see her doctor. Recently she got fed up and tried to take her business elsewhere. Her time was too valuable. She couldn’t be made to wait.

However, in the end, she stayed with her doctor — because they had built a strong relationship. Ironically, it was the time that the doctor insisted on spending with patients that allowed her to predict a stroke in one case immediately before it happened (she waited with the patient as the stroke developed and an ambulance came). She was able to send a patient to a neurologist for memory loss because she noticed him repeating things up to three times (this wouldn’t have happened if the visit had been kept at ten minutes). The doctor offers her card to teens and allows them to call her anytime with questions regarding sex, drugs and depression (things teens often don’t want to open up to parents about).

Ann Brenoff has her eye on the same trends we’re following. She explains:

“Reducing the time doctors spend with patients is nothing new in medicine, of course. The trend for years now is to spend less time with patients and more with their test results on a computer. It’s what young doctors are taught in school. A study published in the Journal of General Internal Medicine in August found that interns spent just 12 percent of their time in direct patient care. The rest of the time is spent on computers or on ‘indirect’ patient care.”

That 12% number is too ironic. In our nation-wide efforts to become more “data-driven” and “efficient” docs are left with little time to actually spend with patients. An EMR is not supposed to REPLACE patient-doctor interaction. It’s supposed to ENHANCE it, and make it more viable.

Reading about this unnamed doctor, the way she’s able to connect with patients, it almost sounds like she’s practicing direct care. Unfortunately, she’s not. And that’s where the real power of direct care emerges. In our case, we succeed BY WORKING FOR OUR PATIENTS. In the fee-for-service doctor’s case, only through her apparent expertise and deferred experience is she able to “break the rules” and practice QUALITY primary care.


On one hand, kudos to a doctor willing to resist the red tape. On the other hand, we’d love to see a doc like this cut it out entirely. She should be rewarded for spending time with patients, not barked at from superiors for treating patients like people and not parts on a conveyor belt. And for everyone’s sake, can she be allowed to book 30-minute appointments so that her patients can be seen on time? It’s absurd to book something for one time knowing that it is never going to happen then.